Prospective study of posterior capsule-zonular disruption during extracapsular cataract extraction: eliminating iatrogenic disruption.

We modified our surgical techniques after analyzing the mechanisms responsible for posterior capsule-zonular disruption with or without vitreous loss in 250 consecutive extracapsular cataract extraction cases. We applied the derived principles and prospectively studied the subsequent 1,500 cases. Modifications in our surgical protocol included the use of a Honan balloon for a longer interval (at least 60 minutes preoperatively) and more aggressive surgical expansion of poorly dilating pupils. Furthermore, complete YAG anterior capsulotomy performed after the retrobulbar block appeared to minimize zonular stress associated with mechanical anterior capsulotomy. We reduced the risk of posterior capsule-zonular disruption from 4.8% (2.4% vitreous loss) to zero, eliminating this complication completely in our last 1,000 cases.